# CHRISTIAN CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558763987
- **Authorized official:** DR. JAMES G WAKEFIELD III MD (OWNER)
- **Authorized official phone:** (219) 866-0485

## Contact information

- **Practice address:** 716 S COLLEGE AVE, RENSSELAER, IN 47978-3083
- **Practice address phone:** (219) 866-0485
- **Practice address fax:** (219) 866-0837
- **Mailing address:** 716 S COLLEGE AVE, RENSSELAER, IN 47978-3083
- **Mailing address phone:** (219) 866-0485
- **Mailing address fax:** (219) 866-0889

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01060733A | IN | Yes |

## Other

- **Enumeration date:** 09/17/2014
- **Last updated:** 09/14/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 20052387OA | — | IN |